Traditional activities and general and mental health of adult Indigenous peoples living off-reserve in Canada

IntroductionWe examined associations between traditional Indigenous activities and self-perceived general and mental health in adult Indigenous persons living off-reserve in Canada using the 2012 and 2017 Aboriginal Peoples Surveys (APS), the two most recent datasets. We utilized four traditional Indigenous activities including hunting, making clothes or footwear, making arts or crafts, and gathering wild plants to investigate these self-reported data.MethodsData from 9,430 and 12,598 respondents from the 2012 and 2017 APS, respectively, who responded to 15 questions concerning traditional activities were assessed using multivariable logistic regression to produce odds ratios (OR) and 95% confidence intervals (CI). Covariates included age, sex, education-level, income-level, Indigenous identity, residential school connection, ability to speak an Indigenous language, smoking status, and alcohol consumption frequency.ResultsUsing the 2012 APS, clothes-making was associated with poor self-reported general (OR = 1.50, 95%CI: 1.12–1.99) and mental (OR = 1.59, 95%CI: 1.14–2.21) health. Hunting was associated with good mental health (OR = 0.71 95%CI: 0.56–0.93). Similarly, 2017 analyses found clothes-making associated with poor general health (OR = 1.25, 95%CI: 1.01–1.54), and hunting associated with good general (OR = 0.76, 95%CI: 0.64–0.89) and mental (OR = 0.69, 95%CI: 0.58–0.81) health. Artmaking was associated with poor general (OR = 1.37, 95%CI: 1.17–1.60) and mental (OR = 1.85, 95%CI: 1.58–2.17) health.ConclusionHunting had protective relationships with mental and general health, which may reflect benefits of participation or engagement of healthier individuals in this activity. Clothes-making and artmaking were associated with poor general and poor mental health, possibly representing reverse causation as these activities are often undertaken therapeutically. These findings have implications for future research, programs and policies concerning Indigenous health

Institutional Engagement Practices as Barriers to Public Health Capacity in Climate Change Policy Discourse: Lessons from the Canadian Province of Ontario

Public health engagement in the communication, discussion, and development of climate change policies is essential for climate change policy decisions and discourse. This study examines how the existing governance approaches impact, enable, or constrain the inclusion, participation, and deliberation of public health stakeholders in the climate change policy discourse. Using the case study of the Canadian Province of Ontario, we conducted semi-structured, key informant interviews of public health (11) and non-public health (13) participants engaged in climate change policies in the province. The study results reveal that engagement and partnerships on climate change policies occurred within and across public health and non-public health organizations in Ontario. These engagements impacted public health’s roles, decisions, mandate, and capacities beyond the climate change discourse; enabled access to funds, expertise, and new stakeholders; built relationships for future engagements; supported knowledge sharing, generation, and creation; and advanced public health interests in political platforms and decision making. However, public health’s participation and deliberation were constrained by a fragmented sectoral approach, a lack of holistic inter-organizational structures and process, political and bureaucratic influences, irregular and unestablished communication channels for public health integration, and identities and culture focused on functions, mandates, biased ideologies, and a lack of clear commitment to engage public health. We conclude by providing practical approaches for integrating public health into climate change discourse and policymaking processes and advancing public health partnerships and collaborative opportunities

Complex contaminant mixtures and their associations with intima-media thickness

Abstract Background The burden of cardiovascular disease (CVD) morbidity and mortality is higher among Indigenous persons, who also experience greater health disparities when compared to non-Indigenous Canadians, particularly in remote regions of Canada. Assessment of carotid intima-media thickness (cIMT), a noninvasive screening tool and can be used as biomarker to assess increased CVD risk. Few studies have examined environmental contaminant body burden and its association with cIMT. Methods Data from the Environment-and-Health Study in the Eeyou Istchee territory of northern Québec, Canada was used to assess complex body burden mixtures of POPs, metals and metalloids among (n = 535) Indigenous people between 15 and 87 years of age with cIMT. First, Principal Component Analysis (PCA) was used to reduce the complexity of the contaminant data. Second, based on the underlying PCA profiles from the biological data, we examined each of the prominent principal component (PC) axes on cIMT using multivariable linear regression models. Lastly, based on these PC axes, cIMT was also regressed on summed (Σ) organic compound concentrations, polychlorinated biphenyl, perfluorinated compounds, respectively, ∑10 OCs, ∑13 PCBs, ∑3PFCs, and nickel. Results Most organochlorines and PFCs loaded primarily on PC-1 (53% variation). Nickel, selenium, and cadmium were found to load on PC-5. Carotid-IMT was significantly associated with PC-1 β = 0.004 (95 % CI 0.001, 0.007), and PC-5 β = 0.013 (95 % CI 0.002, 0.023). However, the association appears to be greater for PC-5, accounting for 3% of the variation, and mostly represented by nickel. Results show that that both nickel, and ∑3PFCs were similarly associated with cIMT β = 0.001 (95 % CI 0.0003, 0.003), and β = 0.001 (95 % CI 0.0004, 0.002), respectively. But ∑10OCs was significantly associated with a slightly greater β = 0.004 (95 % CI 0.001, 0.007) cIMT change, though with less precision. Lastly, ∑13PCBs also increased β = 0.002 (95 % CI 0.0004, 0.003) cIMT after fully adjusting for covariates. Conclusion Our results suggest that environmental contaminants are associated with cIMT. This is important for the Cree from the Eeyou Istchee territory who may experience higher body burdens of contaminants than non-Indigenous Canadians

Environmental contaminant body burdens and the relationship with blood pressure measures among Indigenous adolescents using Bayesian Kernel Machine Regression: Results from the Nituuchischaayihtitaau Aschii: Multi-Community Environment-and-Health Study in Eeyou Istchee, Quebec, Canada, 2005–2009

Background: Early onset hypertension among youth has important cardiovascular health implications later in life. Persistent organochlorine pollutants, polybrominated diphenyl ethers (PBDEs), and toxic metals have been associated with adverse cardiovascular outcomes. Objectives: This study examined body burdens of environmental contaminants and blood pressure measurements (BP) among adolescents. Methods: We used data collected from the Multi-Community Environment-and-Health Study. First Nation adolescents with valid contaminant and BP measures were eligible. Principal Component Analysis (PCA) produced orthogonal principal component (PC) axes that were subsequently used as independent predictors in modified Poisson regression models, with robust variance estimation. Prevalence ratios (PR) with corresponding 95% confidence intervals (95% CI) were derived for elevated blood pressure (EBP), which was defined as systolic (SBP≥120 mm Hg or diastolic DBP)≥80 mm Hg according to new clinical practice guidelines for BP screening among adolescents between 13 and 19 years of age. Bayesian Kernel Machine Regression (BKMR) further examined individual contaminant contributions on continuous BP measures. Results: In total there were (n=148; 47 % females) First Nation adolescents. Prevalence of EBP, was 29%. Four PCs were extracted from the PCA analysis. The first axis (PC-1) explained 45% of the total variance, showing positive, primarily high loadings from polychlorinated biphenyl congeners (PCB). PBDEs loaded highly on PC-2, explaining 18% of the variation. Toxic metals (i.e., lead and mercury), and cadmium highly and positively loaded on PC-3 and PC-4, accounting for 11% and 10% of the variation, respectively. EBP was significantly associated with increasing PC-2 (i.e., PBDEs) across all adjusted models, fully adjusted model (PR=1.21; 95% 1.05, 1.40). Results from BKMR bolster the findings from the PCA and regression models. Conclusion: In this cross-sectional analysis, exposure to PBDE, specifically, PBDE-47 may adversely affect BP measures among young First Nation adolescents in Canada

Subsistence fishing in the Eeyou Istchee (James Bay, Quebec, Canada): A regional investigation of fish consumption as a route of exposure to methylmercury

Fishing is part of the traditional activities of Indigenous people in Canada. However, it is also a route of exposure to methylmercury, a known neurotoxicant, and this is a concern for those who rely on fish as part of their diet. The probable weekly intake (PWI) of methylmercury from six species of fish was calculated for Indigenous community members (N = 1406), grouped by age and sex, and compared to Canadian and international provisional reference doses to assess exposure. Mixed-effects regression models were also used to estimate the input of methylmercury into the blood, and Hazard Quotients (HQ) were used to assess potential effects. Of the species of fish in our study, walleye and lake trout contributed the most to methylmercury intake. There was a positive association between the consumption of walleye and the total blood mercury concentrations of mercury in women and men (R2A = 0.40 and 0.47, respectively), and to a lesser extent, children. Similar results were observed for the consumption of lake trout. The 95th-percentile HQ for girls (3.16) and boys (3.18) from the consumption of lake trout was relatively high, and to a lesser extent, so was the HQ for walleye and pike. The consumption of some species of fish increases the exposure to methylmercury, however, taking a balanced approach, there are health benefits associated with the consumption of fish that must be considered. To mitigate future exposure to methylmercury, we recommend follow-up blood monitoring and local-geospatial-based assessments

Using a geographic information system to assess local scale methylmercury exposure from fish in nine communities of the Eeyou Istchee territory (James Bay, Quebec, Canada)

Exposure to methylmercury is a concern for those who rely on fish as a traditional food in the Eeyou Istchee territory of James Bay, Quebec, Canada, because industrial land uses overlap with community water bodies where fish are harvested. Consequently, this study assessed if traditional practices, particularly fishing, increased the risk of exposure to methylmercury from the consumption of locally harvested fish. We designed a geographic information system (GIS) that included land use and fish methylmercury tissue concentrations to assess clustering of potential hot spots. We also used generalized linear models to assess the association of fish consumption to blood organic-mercury concentrations, and logistic regression models to assess the probability of fish exceeding the safety threshold for methylmercury tissue concentrations in areas of high intensity land use. The GIS demonstrated significant clustered hot spots around regions of hydroelectric and mining land use. Our results also revealed that adult consumption of pike, lake trout and/or walleye, and child consumption of pike or walleye were significantly associated with blood organic-mercury concentrations. Further, large fish harvested in a community with high intensity land use yielded a 77% probability that the fish exceeded the safety threshold. From a human exposure perspective, our study highlights the need for further research on children who consume fish from this region

Fisher’s Linear Discriminant Function Analysis and its Potential Utility as a Tool for the Assessment of Health-and-Wellness Programs in Indigenous Communities

Diabetes mellitus is a growing public health problem affecting persons in both developed and developing nations. The prevalence of type 2 diabetes mellitus (T2DM) is reported to be several times higher among Indigenous populations compared to their non-Indigenous counterparts. Discriminant function analysis (DFA) is a potential tool that can be used to quantitatively evaluate the effectiveness of Indigenous health-and-wellness programs (e.g., on-the-land programs, T2DM interventions), by creating a type of pre-and-post-program scoring system. As the communities of the Eeyou Istchee territory, subarctic Quebec, Canada, have varying degrees of isolation, we derived a DFA tool for point-of-contact evaluations to aid in monitoring and assessment of health-and-wellness programs in rural and remote locations. We developed several DFA models to discriminate between those with and without T2DM status using age, fasting blood glucose, body mass index, waist girth, systolic and diastolic blood pressure, high-density lipoprotein, triglycerides, and total cholesterol in participants from the Eeyou Istchee. The models showed a ~97% specificity (i.e., true positives for non-T2DM) in classification. This study highlights how varying risk factor models can be used to discriminate those without T2DM with high specificity among James Bay Cree communities in Canada

Health measures of Eeyouch (Cree) who are eligible to participate in the on-the-land Income Security Program in Eeyou Istchee (northern Quebec, Canada)

Participation in on-the-land programs that encourage traditional cultural activities may improve health and well-being. The Income Security Program (ISP) - a financial incentive-based on-the-land program - for Eeyouch (Cree) hunters and trappers in Eeyou Istchee was created as a result of the 1975 James Bay and Northern Quebec Agreement to help mitigate the effects of hydroelectric development on the Cree people of northern Quebec, Canada. Beyond the ISP's financial incentives, little is known about the health measures of those who are eligible to participate in the ISP (i.e. spent ≥120 days on-the-land during the previous year). Therefore, this paper's objective was to assess the health measures of northern Quebec Cree, who were eligible for participation in the ISP

The self-reported behaviour of Iiyiyiu Aschii Cree and the worry about pollution from industrial and hydroelectric development in northern Quebec, Canada

Worry is influenced by environmental pollution and affects individual health and well-being; however, little is known about this association in Indigenous communities. Using logistic regression models, we examined self-reported responses among Cree adults to the question "Are you worried about the pollution of the environment (land, water or air) in Iiyiyiu Aschii?" to assess if increased worry was associated with proximity to industrial and hydroelectric development, whether increased worry was associated with self-reported behavioural changes of water consumption type in the community or bush, and days spent on-the-land. Proximity to multiple industrial and hydroelectric development sites was associated with increased worry about pollution. Notably, the decreased consumption of tap water in the community was significantly associated with increased worry, but time-on-the land was not. Overall, our study provides new findings concerning development in a Cree territory in northern Quebec, Canada, and the worry about pollution's association with self-reported behavioural changes.This work had financial contributions from the Niskamoon Corporation (agreement number 2005.06) and the Canadian Institutes of Health Research (FRN 156396)

Bird harvesting practices and knowledge, risk perceptions, and attitudes regarding avian influenza among Canadian First Nations subsistence hunters: implications for influenza pandemic plans

Abstract Background There is concern of avian influenza virus (AIV) infections in humans. Subsistence hunters may be a potential risk group for AIV infections as they frequently come into close contact with wild birds and the aquatic habitats of birds while harvesting. This study aimed to examine if knowledge and risk perception of avian influenza influenced the use of protective measures and attitudes about hunting influenza-infected birds among subsistence hunters. Methods Using a community-based participatory research approach, a cross-sectional survey was conducted with current subsistence hunters (n = 106) residing in a remote and isolated First Nations community in northern Ontario, Canada from November 10–25, 2013. Simple descriptive statistics, cross-tabulations, and analysis of variance (ANOVA) were used to examine the distributions and relationships between variables. Written responses were deductively analyzed. Results ANOVA showed that males hunted significantly more birds per year than did females (F1,96 = 12.1; p = 0.001) and that those who hunted significantly more days per year did not perceive a risk of AIV infection (F1,94 = 4.4; p = 0.040). Hunters engaged in bird harvesting practices that could expose them to AIVs, namely by cleaning, plucking, and gutting birds and having direct contact with water. It was reported that 18 (17.0%) hunters wore gloves and 2 (1.9%) hunters wore goggles while processing birds. The majority of hunters washed their hands (n = 105; 99.1%) and sanitized their equipment (n = 69; 65.1%) after processing birds. More than half of the participants reported being aware of avian influenza, while almost one third perceived a risk of AIV infection while harvesting birds. Participants aware of avian influenza were more likely to perceive a risk of AIV infection while harvesting birds. Our results suggest that knowledge positively influenced the use of a recommended protective measure. Regarding attitudes, the frequency of participants who would cease harvesting birds was highest if avian influenza was detected in regional birds (n = 55; 51.9%). Conclusions Our study indicated a need for more education about avian influenza and precautionary behaviours that are culturally-appropriate. First Nations subsistence hunters should be considered an avian influenza risk group and have associated special considerations included in future influenza pandemic plans